Some healthcare IT leaders call it the perfect storm: the buffeting crosswinds of increased regulatory quality reporting, ICD-10 implementation, and the shift to accountable care. Is it any wonder that CIOs and CMIOs are expecting more from their technology solution vendors and service providers?
At a time like this, providers are more focused than ever on making sure their technology investments are having a positive impact on the lives of their patients. The “2013 Best in KLAS Software and Services” report, which produces insights on vendor performance based on feedback from thousands of provider executives, nurses, doctors, technicians, office managers, etc., offers a timely snapshot of an industry in transition. Some vendors are rising to the challenge of meeting and even surpassing customer expectations, and taking on the role of partner rather than just supplier. For instance, athenahealth edged out Epic as the top Overall Software Vendor.
It is the first vendor to do so since 2008, the year KLAS began ranking an overall software leader. Although Epic was unseated by athenahealth for the spot of top Overall Software Vendor, it maintained the No.1 Overall Software Suite ranking. Also, as the industry changes, KLAS adds categories of performance to measure. In this year’s report, which has a streamlined look and feel, the Health Information Exchange and Patient Portal categories, which have been measured for performance in the past, are now eligible for Best in KLAS awards. In addition, with the ICD-10 deadline on the horizon, Computer-Assisted Coding was added as well.
What follows is a segment-by-segment look at some of the trends underlying the shifts in provider ratings of health IT products and services.
When it comes to choosing an EMR for the acute-care setting, health systems continue to focus on integration and continuity, with an eye on choosing a vendor partner to work with over the long term, says Colin Buckley, director of research strategy at KLAS.
Providers do not want to pay for lots of interfaces, which are going to be expensive, complex, and a distraction when they are trying to deal with more strategic issues such as accountable care, Buckley says. Getting ambulatory and inpatient systems talking to each other continues to be a major criterion. “Epic and Cerner have had the strongest integration story across the continuum of care. They continue to be the highest rated and continue to get the most new market share year after year” he says.
Other vendors in this space still have more work to do to achieve similar strength across their integrated portfolio, he notes. For instance, although Allscripts’ third-ranked EMR, Sunrise Clinical Manager, has an integrated ambulatory offering, the company’s focus has been to allow providers to choose different ambulatory systems based on their needs rather than forcing all customers to the fully integrated solution. To date, this has not played out as well in the market, but early customer fedback indicates that this may be changing with Allscripts’ renewed commitment and efforts.
Because of the uncertainties they have to deal with, providers want to chose a vendor that is perceived as “safe,” in the way IBM was perceived in the mainframe and minicomputer market 30 years ago. “Some vendors tout their EMR’s mainstream, open architectures, but providers are not thinking of that first,” Buckley says. “They don’t say, ‘I need the best technology.’ They say, ‘I need the best vendor.’”
Harm Scherpbier, M.D., vice president and chief medical information officer at the five-hospital Main Line Health, in the Philadelphia suburbs, agrees with Buckley about the importance of integration. “From an information systems perspective because you have fewer things to manage, and from a clinical perspective because transitions of care are becoming so important, an integrated system is better for that than a best-of-breed system.” Yet even integrated system vendors need to do a good job of interoperability because you are likely to have to exchange data with community vendors who aren’t on the same system, adds Scherpbier, who is on KLAS’ advisory board.
Other vendors are moving in the direction that Epic and Cerner have taken; the question is the speed at which they will get there, Scherpbier notes. “There is always a tendency to lean toward the safe choice and Epic is perceived that way,” he says. “But that comes at a huge price premium, and there could come a point where there is an opportunity for the other vendors to price their products in ways that would help providers see Epic as getting too expensive.”
Each vendor in this space faces its own particular challenges. In the case of Siemens, for example, some integrated components are still maturing and lack functionality, Buckley says. “There is a perception that Siemens could move a lot faster still. Siemens does have integrated ambulatory and ED systems, but providers that have tried them out, have told us while they are glad that Siemens has made the effort, they are not ready for prime time yet.”
Meditech customers who reported a rough experience rolling out 6.0, are starting to indicate that things are getting better, Buckley says. Besides more time to catch up, there may be a shift in perspective on Meditech’s side in terms of how much handholding providers need and expect.
“Providers want vendors that will not just give them the tools but be partners and guide them in terms of what has worked in other organizations,” he says. “That is a big part of why industry leaders like Epic and Cerner succeed.”
One hospital IT leader who recently chose Meditech is Deepak Chaudhry, vice president of information technology at the four-hospital Nexus Health Systems, based in Houston. After initially looking at Cerner, his team chose Meditech 5.66 in 2013 as it goes from paper to digital in its specialty hospitals. “It is not a Rolls Royce, but it works,” Chaudhry says. Initially the project got off to a bumpy start, he adds. “This is a completely new venture for us. We felt we needed more handholding and Meditech assumed we didn’t need it. But after some better communication, we are now getting that attention we need.” After hearing about the initial problems customers had with Meditech 6.0, Chaudhry says, “I wiped my brow and was glad we were not doing that.”
McKesson’s Paragon Clinicals is a system to keep an eye on, Buckley says. McKesson has named it as their go-forward, integrated product over its Horizon platform, but Paragon is also lacking vetted ambulatory and ED systems. In addition, community hospital customers have reported that service has slipped a bit over the past year and that McKesson has been distracted with larger customers. McKesson is aware of the issue and is seeking to address it, he says.
Overall, the vendor scores in the community hospital space are low. Provider expectations have risen in recent years as meaningful use and other challenges have arisen. “The pressure is on. They have greater expectations for what those systems can do, and yet they don’t have more money than they used to have,” Buckley says.
In the community hospital space, the providers have been generally dissatisfied with their vendors and systems for quite a while, notes Judy Hanover, research director for provider IT strategies at IDC Health Insights in Framingham, Mass. “As the market begins to move from fee for service to accountable care and population health management, those systems are not architected to help them and they are not able to transition to patient-centered medicine. That is one reason for so much consolidation.”
Many hospitals decided not to replace their legacy system for the initial stages of meaningful use, but understand they must upgrade soon. For Meditech and McKesson, it raises the question of how many of the hundreds of hospitals on their legacy systems will move to their newer version.
“In Meditech’s case, a good portion feel that moving to Version 6 is a natural progression for them,” Buckley says. “On McKesson’s side, we see a fair number of Horizon customers committing to Paragon, but also a fair number that are taking a wait-and-see approach. They are hopeful Paragon will be an affordable path forward. We don’t see as many organizations today looking at Allscripts and Siemens in terms of moving from their current system.”
Of course, the effects of consolidation and integration play out on the ambulatory EMR side as well. Both Epic and Cerner have a strong influence in terms of getting health systems to unify on one platform, says Erik Bermudez, KLAS research director. Epic continues to lead the over-75 physician category by a large margin in terms of score. Large independent physician groups have more freedom of choice, so other vendors, including Allscripts, eClinicalworks and NextGen, are considered.
In the mid-size provider organization space (11-75), it is more difficult to keep customers happy, because although the IT demands are as high as in larger physician groups, the IT departments are much smaller, Bermudez says. athenahealth has made great strides and is neck and neck with the leader Epic in this space. “We hear customers really jazzed about athenahealth going above and beyond for them. athenahealth is starting to push into the larger markets and we’re looking forward to validating their performance there.”
The 1-10 physician EMR market is still crowded, but Bermudez believes that perhaps meaningful use Stage 2 and ICD-10 will prove too difficult for some of the systems to keep up with. SRSsoft, the Best in KLAS winner in the 1-10 physician market, started as a software vendor for only the orthopedic specialty, but because of market needs and pressures, has been able to successfully cater to other specialties as well. The founder of e-MDs (No. 3) recently returned to the CEO post and has done a good job of bringing back focus, Bermudez adds. “They have a good reputation in the market. They are considered often in small-practice decisions, but not by the larger ones. It will be fun to watch where e-MDs goes from here.”
Practice Fusion (No. 4), a popular free EMR, is doing a solid job for their customers and setting expectations, he says. Practice Fusion might be a good choice for certain practices that are looking for very low-cost or free and compliant software.
IDC Health Insights’ Hanover notes that in one of her firm’s recent surveys, the majority of providers in the ambulatory market were dissatisfied or neutral about their EHR. Twenty-two percent said they had already replaced their EHR and 20 percent said they plan to. “Largely it was a lack of efficiency and productivity,” she explains. “They feel they still aren’t back to where they were on paper in terms of efficiency. A focus on workflow and functionality will benefit the EHR vendors in this space.”
In the PACS market, there haven’t been many new innovations differentiating the players, although the envelope is being pushed in the areas of analytics and decision support, says Kirk Ising, vice president of research strategy at KLAS. A European company, Sectra, continues to make inroads in larger hospitals in America and moved up to Best in KLAS this year. “They have a solid product and have done a good job of communicating with their customer base, and that has paid off well,” Ising says. He noted that FujiFilm (No. 3), after some down years, has a very solid product with Synapse. “They have a huge customer base in radiology and are hitting their stride again.” Another company to keep an eye on is Infinitt with its customer score of 91.4. Although the data is still preliminary in the large acute space, Ising says, the company does a great job with customers and offers good functionality.
In the community hospital setting, customers are more price-conscious and are dealing with less complexity in terms of bringing images from multiple sites and multiple patient identifiers. There tends to be more physician input on the decisions. In that category Avreo interVIEW won Best in KLAS. “Avreo is a solid small company with a clear focus on this niche,” Ising notes. Infinitt has also been consistently strong in this area.
The radiology information system (RIS) market remains driven by the need for interoperability, Ising explains. “Epic Radiant is solid but RIS is not going to blow anybody away with functionality; however it is fully integrated and it is hard to beat that. If you are an Epic EMR customer, you are probably happier with your RIS than if you are a Meditech customer.”
In the community hospital space, Avreo InterWORKS took Best in KLAS. “In smaller hospitals and imaging centers, the radiologists have a bigger say,” Ising explains. “They are more likely to get integrated RIS/PACS that is more workable for them.”
Cardiology and Oncology
In the cardiology space, one emerging trend is the recognition that it is no longer reasonable to purchase separate systems for each cardiology modality, says Monique Rasband, KLAS cardiology research director, and that is one reason that Merge Healthcare Cardio has emerged as Best in KLAS. “Merge has been adding modules and has expanded its suite of offerings,” she adds. “They have also done the handholding with their clients and expanded its integration.” With Digisonics, No. 2 in the rankings, we haven’t seen a lot of growth in new customers or wide adoption of cath reporting, she says, but they still offer excellent customer service on the echo side. Siemens, No. 3 on the list, has had positive reviews about added functionality and support.
Fujifilm has been fun to watch in this space, she adds. “They moved up from last year after they rolled out a new version and got excellent response.” GE’s customers are optimistic about their new platform, despite recent scores not being great. Agfa, No. 9 on the list, “has had functionality and support issues but the customers are hopeful they will see improvement ,” she says. McKesson and Philips have been consistent while being so customizable for LUMEDX has been a double-edge sword. Infinitt is a new player in this space and early data is very positive. They will be one to watch.
In the oncology information system market, two best-of-breed solutions, Eleckta MOSAIQ (Category Leader) and Varian ARIA, continue to be preferred over offerings from enterprise vendors for a full oncology offering. These two best-of-breed vendors are very popular and handle both medical oncology and radiation therapy.”
“A provider said to me, if it were easy to create an oncology offering, the vendors would have done it a long time ago,” Rasband says. “The major vendors are just getting products out to the market now. Cerner’s is seeing growth; McKesson purchased iKnowMed, a US Oncology solution that has proven to be robust as well as serve medical oncology. Epic has been working on medical oncology for a number of years, and while they are seeing growth, providers are still waiting for maturity but remain optimistic they will get there.